tightening the LES

  I was watching a medical show today and one of the doctors said
  the LES can be tightened by taking a prokenetic agent. Is this
   true and is it a permanant fix, or does the LES loosen again
  when the medication has been stopped? I always thought that meds
   must be taken for life in patients with GERD Also what are some
   prokenetic agents?  Thank you.
     Cathy
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Dear Cathy,
Yes, it is true that the tone of the lower esophageal sphincter (LES) can be increased by certain medications. Prokinetic agents will increase the LES pressure as well as promote gastric emptying. By increasing the motility of the stomach, contents are more rapidly propelled out of the stomach and less likely to reflux into the esophagus.  
Available prokinetic agents, that are prescribed for reflux, are Cisapride, and Metoclopramide,  Although both medications are considered safe, Cisapride has been associated with cardiac arrhythmias and Metoclopramide with tremors.   Usually these drugs are used in conjunction with a medication that inhibits acid secretion i.e. an H2 receptor antagonist or a proton pump imhibitor.  You are correct that the beneficial effect stops when the medication is discontinued.
Although reflux is a chronic problem, most patients do not require continuous medical therapy.  Effective therapy starts with life-style modifications that include head of bed elevation, smoking cessation, dietary therapy (avoidance of fatty foods, chocolate and excessive alcohol), weight loss, refraining from assuming a supine position immediately after meals and avoidance of meals immediately before bedtime.   Medications are used as needed to control the symptoms when lifestyle modifications are insufficient.
This information is provided for educational purposes only.  Always consult your personal physician for specific medical questions
HFHSM.D.-sg
*keywords: esophageal reflux
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